Application for Employment

All questions contained within this Application for Employment are to be answered. The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to programs, services and employment is available to all persons. Any applicant requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resource Department.

Position(s) interest

Referral Source:

First Name:

Middle Name:

Last Name:

Address:

City:

State:

Zip:

Email:

Enter Telephone Number in 555-555-5555 format.

Tel:
- -

Alternate Tel:
- -

Are you legally eligible for employment in this country?

Yes
No

If you are under 18, can you obtain working papers?
Yes
No
N/A
If no, please explain:

Have you been employed with Redstone Highlands, Redstone@Home and/or Senior Independence before?
Yes
No
If yes, dates:
From (mm/dd/yyyy):
/
/
To (mm/dd/yyyy):
/
/

Type of employment desired:

Will you work overtime if required?
Yes
No
If no, please explain:

Have you been charged or convicted of any crime including misdemeanor offenses excluding summary offenses?
Yes
No
If yes, provide the following details:
Date, charge, place, disposition, court, action taken, sentence.

Do you have any founded actions of abuse or have you been convicted of any offense related to the abuse, neglect, or mistreatment of any clients, residents, or others?
Yes
No
If yes, provide all information regarding the founded actions.

Do you have a current driver's license?
Yes
No

List the names of all relatives working for Redstone Highlands, Redstone@Home and/or Senior Independence. Type in NONE if not applicable.